Social Determinants

1. Module 1 Lecture
Within module one we are going to be focusing on the definition of public health, the social
determinants of health, and also looking at some of the past contributions to the field of public
health. So within this module our learning objectives will be to define public health, to broadly
characterize the association between public health and population health, to review the 10
essential public health services, to explain the social determinants of health and how they fit into
the scope of public health, and then to review some current events to see how all of those play a
role in the field of public health.
So before we get started just take a couple of minutes and write down a few words that describe
what public health means to you. They can range from education, from knowledge, from medical
care. Any of those words that kind of describe public health to you, take a couple of minutes and
write those down. After you write down those words, let’s reflect on what public health actually
means. So this chart right here kind of gives us an idea of some of the words that reflect the
meaning of public health. But when we look at public health as far as the definition, there are
varying definitions that define public health.
Public health promotes and protects the health of people and the communities where they live,
learn, work, and play. That definition is given by the American Public Health Association.
Another definition of public health is that it is the science of promoting health, preventing
disease, and premature death of a population by systemic efforts of society, communities, or
individuals usually in the presence of limited financial resources. That really encompasses what
this class is about when discussing vulnerable populations. And then the definition that is given
by the Centers of Disease Control states that public health is the science of protecting and
improving the health of people and their communities. This work is achieved by promoting
healthy lifestyles, researching disease and injury prevention, and detecting, preventing, and
responding to infectious diseases.
So when you look at public health it’s not just one field as far as there is not just one measure of
public health, there is not just one dimension of public health. There are so many core areas that
you could focus on. So when we look at some of those core areas, they include behavioral
science and health education, biostats, environmental health, epidemiology, maternal and child
health, and nutrition, just to name a few. And this list is not all inclusive of everything that public
health encompasses, but it just gives us a general idea of some of the areas that you could
actually work in or do research in in the field of public health.
So when we focus on some of the public health contributions, public health helps to prevent
epidemics and the spread of disease, it also protects against environmental hazards, prevents
injuries, promotes and encourages healthy behaviors, responds to disasters and assists
communities in recovery, and assures the accessibility of health services. So each one of those
areas are things that public health can assist the community in doing. So when you think of the
public health contributions and then look at some of the core areas of public health, you can see
how things such as preventing epidemics would link to epidemiology and would also link to

2. public health policy or public health practice. Or when you look at preventing injury, that could
link to maternal and child health and then it could also link to emergency medical services.
So within the field of public health, there are 10 essential public health services. So public health
is in place to monitor health, to diagnosis and investigate, to inform educate and empower, to
mobilize community partnerships, to develop policies, to enforce laws, to link to and provide
care, to assure a competent workforce, to evaluate and to research. So if you compare a lot of
these different public health services to the article that we read that goes with this module, you
will see how monitoring health or researching different aspects of health fall into the field of
public health.
Also looking at the chart of the essential public health services that are offered, this chart just
gives you a couple example of how these different public health services are offered to a
community. So when you look at monitoring health, maybe doing a community health
assessment, maybe in an area you realize that there is a high prevalence of teenage pregnancy so
then you need to do a community needs assessment to see why the teenage pregnancy rate in the
area is so high. Is it a lack of education? Are there other things that are playing a role that makes
that a big factor within that community? In the same manner you can look at test scores. If a
certain area has lower test scores than another area what are some of those factors that are
playing a role in why those test scores are so low? Another example of how an essential public
health service falls into the field of public health is mobilizing community partnerships. So when
we look at mobilizing community partnerships, a lot of times there are non-profit organizations
within the community that help to provide some of the services that some of your private entities
or even public entities are not able to offer to the community. If you look at infant mortality,
within the metroplex, there are certain non-profit agencies such as the March of dimes that could
help to combat infant mortality in a way that some of the private entities or public entities such
as hospital systems would not be able to provide that same service. So that would be one of the
public health services that would help to decrease the impact of infant mortality in a certain
community.
The social determinants of health play a large role also in the field of public health. Social
determinants of health care conditions in the environments in which people are born, live, work,
play, worship, and age that affect a wide range of health functioning and quality-of-life outcomes
and risks. Addressing these factors of social determinants of health are important for a number of
reasons, but three that are really important are these factors underlie preventable disparities in
health status and disease outcomes. These policies that result from social determinants of health
can provide changes to the social and physical environment and these policies can be developed
to aid in those changes. And then they can also improve conditions that can improve national
productivity, security, and prosperity through a healthier workforce.
So if you look at some of the social determinants of health and population health on this chart,
you can see how much the social determinants of health affect a person in their daily life. So if
you look at the physical environment, its about 10 percent that it can make a difference in a
person’s health outcomes. Health care, access to quality health care and being able to get to
health care is about 20%. Health behaviors such as tobacco use, diet and exercise, alcohol use,

3. and unsafe sex is about 30 %. Then socio-economic factors such as education, employment,
income, family and social support, and community safety is about 40%. If you look on this chart
physical environment and socio-economic factors really make up 50% together because your
physical environment can also determine what your socio-economic factors are. So depending on
where you live, your geographic location, can really make a difference on your education, your
employment, on your income, and the community safety. So those goes hand in hand in how
they determine what your health outcome could be.
This chart gives you another example on how those social community networks and individual
lifestyle factors all play a role in how your health outcomes could make a difference based on
your social determinants of health.
Do you think that social determinants of health play a role and if so why? And you can just think
about that as you go through some of the social determinants of health and look how that plays a
role in some of the public health issues and events that you feel are important or that you feel
you are passionate about.
So in addition to looking at public health as a definition and social determinants of health, within
this module we also want to look at the past contributions of public health and how they play a
role in the field of public health.
So the learning objectives for this section will be to review the past contributions of public health
and to briefly discuss some of the 20th century public health achievements.
One of the first public health contributions that we will look at and you have a video in your
module that will give you a little more detail on Henrietta Lacks, but we will look at the story of
Henrietta Lacks.
Henrietta Lacks was a poor black tobacco farmer whose cells were taken without her knowledge
in 1951 after she died from cervical cancer and those cells, later know as HeLa cells because
really important in the field of public health and also in the field of medicine because with them
they were able to develop the polio vaccine, they were able to do cloning, gene mapping, in vitro
fertilization, and also chemotherapy. So these cells were seen as the first immortal human cell
line in history. But then you have to look at what are some of the ethical issues surrounding those
HeLa cells? Some of the ethical issues were that the family did not make any money from those
cells and then the family also did not give permission for those different companies to use the
cells for the different ways that they did. So when we look at some of these past public health
contributions, we are really focusing on how they introduced some of the ethical issues in public
health and looking at how they transformed the field to make sure that there is informed consent
especially in the field of research.
The next one is the Tuskegee Syphilis Experiment and I really urge you to read the articles that
are within the module and to also just do your own research on some of these past public health
contributions because they are really interesting and it gives you a sense of what has been done
and why things are the way they are now.

4. So the Tuskegee Syphilis Experiment was a study conducted to record the natural history of
syphilis in hopes of justifying interventions for Blacks. The men were lured into this study with a
promise of free treatment for “bad blood” along with free meals, free physicals and free burial
insurance. So all of the men that participated in the study were Black and of low income. The
experiment was conducted to study the progression of the syphilis without treatment so although
many of the men thought they were being treated most of them were not. Even though a
treatment came out, penicillin came out as an effective treatment back in 1945 a lot of these men
were still not given penicillin hat were part of the Tuskegee Study. So just think about some of
the ethical issues that also surround this study and the field of public health and how some of
those ethical issues change the way that we do things in public health now.
Same with the Stanford Prison Experiment. So the aim of this study was to investigate how
readily people would conform to the roles of guard and prisoner in a role-playing exercise that
simulated prison life. So one of the researchers decided that he was going to develop a study
where he gave a role to each of these college students. Some of the college students were
prisoners and some of the college students were prison guards. He wanted to record their
personality based on the role that they were given. One of the things he wanted to see, was to see
if the attitudes of the guards and prisoners changed based on dispositional which is their
personality or if it had to do with situational which was the actual prison environment. So the
findings supported the situational explanation of behavior rather than the dispositional one
meaning that people will readily conform to the social roles they are expected to play especially
if those roles are as strongly stereotyped as those of the prison guards.
That also helped us to come up with some of the research practices for public health including
the informed consent, public health ethics, and the institutional review board.
So let’s look at some of the 20th century public health achievements. Again, this is not an all-
inclusive list, but we can look at some of the things that have happened within the 20th century
that can be accredited to public health. So fluoridation of the drinking water, reductions in
prevalence of tobacco use, vaccination to reduce epidemic disease, improved motor vehicle
safety, that includes seatbelt safety, safer workplaces, control of infectious disease, a decline in
death from cardiovascular disease. Food safety, improvement in maternal and child health, and
family planning. So all of those things can really be attributed to public health. So now as you
go through this module make sure that you do the readings and that you watch the videos and
that you participate and complete the module essay because that will really help you to get an
idea of how your ideas in public health translate into the definitions of public health and social
determinants of health.